Clinicoradiological correlation of type 1 tympanoplasty in wet and dry ears
Keywords:Chronic suppurative otitis media, Wet ear, Tympanoplasty type 1, Mastoid opacification
Background: Chronic otitis media patients can present with a dry or wet ears (which means those ears which have a mild mucoid discharge and are negative on culture). Preoperative HRCT scans done in these patients show either a normal or an opacified mastoid cavity. This creates a dilemma in the mind of an otologist as whether doing a tympanoplasty in a patient with an active mucoid ear discharge would be beneficial or not. The goal of this study is to compare results of type 1 tympanoplasty in wet and dry mucosal COM ears and correlate between preoperative CT findings and postoperative outcomes.
Methods: A comparative study was done where a total of 30 wet and 30 dry ears respectively were included based on a preset clinical criterion. After a detailed history, otoscopic examination, pure tone audiometry (PTA) and a HRCT scan of temporal bone, all patients underwent type 1 tympanoplasty followed by PTA assessment 2 months postoperatively.
Results: The graft uptake rates and hearing outcomes after surgery were found to be similar in both wet and dry ears. Also, the graft uptake rates in patients with opaque mastoids were similar to those with normal mastoids on HRCT scans.
Conclusions: This study concludes that success of type 1 tympanoplasty surgery is not adversely affected by the presence of mucoid discharge at the time of surgery. For achieving good surgical success, meticulous graft placement is more important rather than status of the operated ear.
Muftah S, Mackenzie I, Faragher B, Brabin B. Prevalence of Chronic Suppurative Otitis Media (CSOM) and Associated Hearing Impairment Among School aged children in Yemen. Oman Med J. 2015;30(5):358-65.
World Health Organisation. Chronic suppurative otitis media: Burden of illness and management options. World Health Organisation. Geneva. 2004.
Meyerhoff WL, Kim CS, Paparella MM. Pathology of chronic otitis media. Ann Otol Rhino Laryngology 1978;87(6Pt 1):749-60.
Mittal R, Christopher LV, Gerring R, Mittal J, Mathee K. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015;64,1103-16.
Toss M. Manual of middle ear surgery, Approaches, Myringoplasty, Ossciculoplasty and Tympanoplasty, Vol, 1. 1993;7-10.
Wullstein H. Theory and practice of tympanoplasty. The Laryngoscope. 1956;66:1076-93.
Bhatt NA, Rnit De. Retrospective analysis of surgical outcome, symptom changes, and hearing improvements following myringoplasty. J Otol. 2000;29(4):229-32.
Webb BD, Chang CY. Efficacy of tympanoplasty without mastoidectomy for chronic suppurative otitis media. Arch Otolaryngol Head Neck Surg. 2008;134(11):1155-8.
Onofre R, Ha SC, Yang CJ, Lee HS, Lee JY, Yoo MH et al. Prognostic roles of preoperative CT findings and air-bone gaps in type 1 tympanoplasty. Acta Otolaryngol. 2018;138(9):795-800.
Kim H, Bae HY, Choo OS, Choung YH. Efficacy of tympanoplasty without mastoidectomy for treating chronic otitis media in patients with mastoid cavity opacification in temporal bone computed tomography findings. Clin Exp Otorhinolaryngol. 2018;11(1):30-4.
Nagle S, Jagade M, Gandhi S, Pawar P. Comparative study of outcome of type I tympanoplasty in dry and wet ear. Indian J Otolaryngol Head Neck Surg. 2009;61(2):138-40.
Yung MW. Myringoplasty for subtotal perforation. Clin Otolaryngol. 1995;20:241-5.
Wasson J, Papadimitriou C, Pau H. Myringoplasty: Impact of perforation size on closure and audiological improvement. J Laryngol Otol. 2009;123(9):973-7.
Adkins WY, White B. Type I tympanoplasty: influencing factors. Laryngoscope. 1994;94:916-8.
De Bolini Lima JC, Monteiro Marone SA, Martucci O, Gonc ̧alezF, Da Silva Neto JJ, Carolina Mataruco Ramos A. Evaluation of the organic and functional results of tympanoplasties through a retro-auricular approach at a medical residency unit. Braz J Otorhinolaryngol. 2011;77(2):229-36.
Dhar G, Basak B, Chandra Gayen G, Ray R. Outcome of myringoplasty in dry and wet ear – a comparative study. J Dental Med Sci. 2014;13:2279.
Hosny S, El-Anwar MH, Abd-Elhady M, Khazbak A, El FekyA. Outcomes of myringoplasty in wet and dry ears. Int Adv Otol. 2014;10(3):256-9.
Shankar R, Virk RS, Gupta K, Gupta AK, Bal A, Bansal S. Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study. J Laryngol Otol. 2015;129(10):945-9.
Gamra OB, Nacef I, Romdhane N. Tympanoplasty outcomes in dry and wet ears. Otolaryngol Open J. 2016;2(2):51-7.
Naderpour M, Shahidi N, Hemmatjoo T. Comparison of Tympanoplasty Results (Hearing Improvement and GraftImplant) in Dry and Wet Ears. Iranian J Otorhinolaryngol. 2016;28(2).
Claes J, De Heyning V, Creten W, Koekelkoren E, Van LaerC, De Saegher D. Allograft Tympanoplasty. Predictive value of preoperative status. Laryngoscope. 1990;100(12):1313-8.
Toros SZ, Habesoglu TE. Do patients with sclerotic mastoids require aeration to improve the success of tympanoplasty? Acta Otolaryngol Supp. 2010;130(8):909-12.